ScrewLoose

     Josh was a shy 8 year-old from a group home. He was reclusive, preferring to sit alone and build cars with Leggos while other kids played sports. He spoke with a rasp, as if he had a hoarse voice from a Strep infection. Eye contact was painful for him, so he kept his gaze locked on the ground when he spoke to you.
     Josh was admitted to the latency unit for acute psychosis. He scanned the ward with spooked eyes, seeing bizarre hallucinations. He batted at the air with his fists, warding off some unseen predator. He could hardly stand, his brain buzzing with interference. When I tried to talk to him, he looked at me as if I was the Grim Reaper, my scythe poised over his neck.
     This was all unexpected, because Josh wasn’t schizophrenic. He was diagnosed with attention deficit disorder and ODD a few months ago. After being stabilized on Ritalin and Mellaril, he was sent back to the group home. His single mother found him too difficult to deal with, and didn‘t feel he was worth investing time in, so she dumped him into the system. Instead of becoming more social, he regressed and interacted only with himself and his stuffed bear.
     This psychotic episode was a mystery to the psychiatrist. He had no clue why Josh was seeing “bad people reaching for him” and hearing “voices talking underwater”. I eaves-dropped on Dr. Copeland’s conversation with his mother, who seemed not to care that Josh was acting crazy. “I don’t know what’s going on, but he’s nutty as a fruitcake,” Dr. Copeland said, and that is a direct quote.
     It took a few hours of investigation to find out what had happened. Two days ago, Josh had suffered an EPS reaction (stiff neck, rolled-up eyes) to Mellaril, and required Cogentin. Later, he had another reaction, and needed a second dose. Then, during a routine pediatrician visit, he complained of seasonal allergies and the doctor prescribed Benadryl. He took two doses of Benadryl, then needed more Cogentin later at night when his neck stiffened up again. In a nutshell, he received more than seven doses of Benadryl/Cogentin due to psychiatrist non-communication.
     An anti-cholinergic psychosis was the result.
     Doctors had made Josh crazy. They theorized about what had gone wrong in his brain; how a screw had “popped loose” and his cerebral motors were misfiring. They even joked about it, as if a lonely little kid that nobody wanted was an object of ridicule. Josh couldn’t sleep for three days, having night terrors and frightening delusions until the medicine cleared itself from his system. He even soaked in the damn stuff, so disoriented and confused he wet the bed twice a night. The doctors blamed serotonin and dopamine and rampant neurotransmitters, but they were the culprits. They had taken a timid, vulnerable kid and put him through two days of hell.
     I wanted to reach into their brains and pull the wiring loose so they knew how Josh felt. Maybe I would get my chance sometime soon.